Director Dispute Resolution

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY: This position is responsible for the oversight and direction of the Arbitration solution. This position is responsible for providing leadership and decision making to ensure high quality service is provided to account management, clients, providers, IDR entities and CMS client's internal customers and vendor relationships. Also responsible for managing or overseeing the management of all activities with the associated units, including developing and implementing policies and procedures on all related systems and work flows to ensure achievement of the department's service and quality standards. This job is responsible for providing the type of leadership, management, and vision necessary to achieve short and long-range business goals and to grow the business unit as well as ensuring operating efficiency. The Director is responsible for directing all facets of the department including staffing, goal setting, budget compliance, product evaluation and enhancement, and policies/procedures to ensure smooth and efficient operations. This job is also responsible for strategic planning and budget decisions. Coordinate communication and activities between all areas within Operations, Sales and Marketing, Human Resources, Network Development, Quality Assurance, IT and Legal departments.

JOB ROLES AND RESPONSIBILITIES:

1. Direct management of performance to ensure competent staff delivers quality results. This includes training, mentoring, motivating, and overseeing staff performance.
2. Develop, implement and manage both short and long term goals, objectives, policies and procedures based on current and future trends and legislative requirements. Stay abreast of industry and/or customer changes and communicate as appropriate.
3. Compile, analyze, and report on trends to include performance improvement initiatives and exceptional client delivery.
4. Oversight and development of operational relationships and performance for clients, account management and other stakeholders.
5. Identify opportunities for performance improvement and operational efficiencies.
6. Manage departmental and team budgets including expenses, cost containment, and profitability.
7. Provide direction and guidance to other levels of management, through delivery of instructions and direction to staff on individual cases and the creation and distribution of goals and standards to team members regularly.
8. Act as a subject matter expert internally for the Team and other departments within the Company.
9. Select, develop, and evaluate staff to ensure the efficient operation of department.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate Company's Core Competencies and values held within.
13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary. Perform weekly Soft Audits on cases work by team members and address performance issues.

JOB SCOPE:

The Director works independently and exercises significant discretion and independent judgment. The incumbent provides input to make critical business decisions, including staffing and process improvement, and impacts day-to-day operations through the oversight of claim resolution and providing direction to staff on individual cases. The incumbent manages and impacts overall department budgets as well as team profitability. The incumbent operates with considerable latitude for unreviewed decisions and uses an extensive range of knowledge to complete job responsibilities. The incumbent manages staff and helps provide thorough and appropriate responses to clients and providers to meet the goals of the department. This role has the authority to recommend and implement appropriate policies, procedures and controls to assure compliance with applicable contractual provisions, regulations, and legislation. This position manages others and has the authority for all HR actions (hiring, firing, discipline, training, etc)